title: A study of the decision outcomes and financial costs of multidisciplinary team meetings (MDMs) in oncology.
abstract: BACKGROUND
  The benefits of multidisciplinary working in oncology are now accepted as the norm and widely accepted as being pivotal to the delivery of optimal cancer care. Central to this are the multidisciplinary meetings (MDMs) and we have evaluated decision outcomes and financial costs of these.
  
  
  METHODS
  We reviewed the electronic patient records of 551 newly referred patients, discussed at 14 tumour site-specific MDMs for adult solid tumours and lymphoma (paediatric oncology and acute leukaemia were excluded) over a 1-month period, a total of 52 MDMs were studied. In addition, the records of a further 81 patients from 10 different MDMs were reviewed where the treating consultant had clearly recorded their opinion of how the patient should be managed and this was compared with the final MDM's consensus view. We also costed the MDMs utilising two different methodologies.
  
  
  RESULTS
  The mean age of the 551 patients in the study was 62 years. In all, 536 (97.3%) patients were treatment naive before MDM discussion and 15 (2.7%) had prior treatment. Median time to treatment after the MDM was 16 days. In 535 (97.1%) cases, the MDM discussions were clearly documented, 16 (2.9%) were not clearly documented. In total, 319 (57.9%) patients were discussed once, and 232 (42.1%) were re-discussed (one to six occasions). In 62 (12.7%) patients, there were delays in MDM discussion, 30 (48.4%) were related to radiology, 26 (41.9%) to histopathology and 6 (9.7%) a combination of both. Adherence to the MDM management plan decision occurred 503 times (91.3%) with 48 (8.7%) deviations. In the smaller cohort of 81 patients, the consultant management plan and MDM consensus was compatible 71 (87.6%) times. On four occasions, there were major alterations in management while six were minor. The cost per month of our MDMs ranged from £2192 to £10 050 (median £5136) with total cost of £80 850 per month and the cost per new patient discussed was £415.
  
  
  CONCLUSIONS
  Adherence to MDM decisions by health-care professionals occurs in the majority of patients. MDMs are costly, which may have relevance in the currently challenged health-care financial environment. There is a need to improve MDM efficiency without losing the considerable benefits associated with regular MDMs.
authors.affiliation: Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK.
authors.forename: P B
authors.initials: PB
authors.lastname: De Ieso
authors.forename: J I
authors.initials: JI
authors.lastname: Coward
authors.forename: I
authors.initials: I
authors.lastname: Letsa
authors.forename: U
authors.initials: U
authors.lastname: Schick
authors.forename: M
authors.initials: M
authors.lastname: Nandhabalan
authors.forename: S
authors.initials: S
authors.lastname: Frentzas
authors.forename: M E
authors.initials: ME
authors.lastname: Gore
mesh_terms: D003657:Decision Making; D019468:Disease Management; D006801:Humans; D033183:Interdisciplinary Communication; D008495:Medical Oncology / Q000191:economics*; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D010348:Patient Care Team / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics